Mid‐ to Long‐term Follow‐up of Severe Acetabular Bone Defect after Revision Total Hip Arthroplasty Using Impaction Bone Grafting and Metal Mesh

Abstract

Objective In revision total hip arthroplasty (THA), reconstruction of severe acetabular bone defect continues to be problematic for orthopedic surgeons. This study reports the mid‐ to long‐term survivorship, radiological outcomes, and complications of impaction bone grafting (IBG) and metal mesh with a cemented acetabular component in the reconstruction of severe acetabular bone defects in revision THA. Methods This retrospective consecutive study included 26 patients (29 hips: type II B, four; type II C, three; type III A, 10; and type III B, 12) who underwent revision THA, which was performed using IBG and metal mesh, between 2007 and 2014 in our institution. All patients were followed up regularly for clinical and radiographical assessments. Migration and loosening of prosthesis graft integration and complications were observed and analyzed. Survival analysis was performed using a Kaplan–Meier survival analysis. Results At the time of revision, 75.9% of the hips (22 hips) were classified as type III bone defects. The average follow‐up period was 9.4 ± 2.8 (range, 2.4–14.0) years. Of the 29 hips, four hips (13.8%) were assessed as clinical failures; at the last follow‐up, two had undergone re‐revision THA, and two had not been scheduled for re‐revision THA despite radiological failure of the acetabular component. Among them, three clinical failures (10.3%) were due to aseptic loosening, and one (3.4%) was due to infection. Radiographic evaluation showed bone graft integration in all hips during the follow‐up. The Kaplan–Meier survivorship analysis revealed an acetabular reconstruction survival rate of 86.5% (95% confidence interval, 61.4%–95.7%) at 10 years. Conclusion IBG and metal mesh with a cemented acetabular component for revision THA is an effective technique for treating severe acetabular bone defects, with effective mid‐ to long‐term outcomes due to the solid reconstruction of the acetabular bone defect and restoration of the hip rotation center.

Trabecular titanium cups in hip revision surgery: a systematic review of the literature

“…Acetabular revision in the presence of a severe bone defect represents one of the most complex challenges ( 11 , 16 - 31 ). In the last decades, different reconstruction techniques using other implants and components have been used ( 11 , 16 - 33 ). To our knowledge, no reviews were performed on the acetabular revision outcome with TT Cups.…”